Plasma Dosage

When to Use

Use to correct deficiencies of clotting factors, for which a specific concentrate is not available, in patients with active bleeding. Inappropriate indications include transfusion in patients without active bleeding or invasive procedures, correction of minimal elevations in INR (i.e., INR <1.7), expansion of circulatory volume, hypoproteinemia, correction of immune deficiencies, transfusion for nutritional purposes, correction of congenital or acquired deficiencies of clotting factors in the absence of hemorrhage, or correction of disorders of hemostasis in patients with chronic liver disease who are not bleeding.

Formula

Pearls / Pitfalls

Transfusion of less than the therapeutic dose of plasma should be discouraged. Plasma should be infused as soon as possible after it is thawed and never be refrozen. Precise prediction of the amount of plasma needed to be transfused to correct a particular coagulopathy is not currently possible. Thus, post-transfusion repetition of the coagulation test that prompted the transfusion is warranted.

Advice

Adverse reactions to the transfusion of FFP include: Allergic reactions: Mild (urticaria): occur in 1% of patients. Severe and anaphylactic: occur with a frequency of <1 case per 100,000 transfusions. Risk for this complication may be reduced by using plasma from male donors who have never been transfused and from nulliparous female donors who have never been transfused, or by using solvent/detergent (S/D) FFP. Transfusion-related acute lung injury (non-cardiogenic pulmonary edema developing within 4–6 hours of the transfusion of FFP). As with anaphylaxis (above), risk may be reduced by using plasma from male or nulliparous female donors who have never been transfused or by using S/D FFP. Febrile reactions: occur in <1% of patients transfused with FFP and in up to 10% of patients undergoing plasma exchange. Citrate toxicity: can occur after the rapid transfusion of large volumes of plasma and is particularly important in neonates and in patients with liver disease. Transmission of infections: the process of freezing inactivates bacteria. Bacterial contamination and growth with release of endotoxins before freezing is extremely improbable. There is, however, still minimal risk of transmission of viral infections or infections due to other unknown or untested pathogens. Circulatory overload: can occur, particularly in patients with renal or cardiorespiratory failure. Inhibitors against deficient proteins: can develop after transfusion of plasma in patients with severe deficiencies of clotting factors. Graft-versus-host disease (GvHD): no known cases of FFP-associated GvHD have been reported. Freezing causes lysis of lymphocytes, so irradiation of the plasma is not necessary.